TABLE 1: Frequently Used Infusion Rates (ml/hr)

Infusion Time 4 hrs 6 hrs

250.0 ml 500.0 ml 62.0 ml/hr 41 125.0 ml/hr 83 62 50 41 21

1000.0 ml 250.0 ml/hr 166 125 100 83 42

8 hrs 31 10 hrs 25 12 hrs 20 24 hrs 10

TABLE 2: Frequently Used Drip Rates (drops per minute) Administration Set drop size 60 drops/ml 20 drops/ml 15 drops/ml 10 drops/ml 41 41 14 10 7 Infusion Rate (ml/hr) 83 83 26 21 13 100 100 32 25 16 125 125 42 31 21 166 166 54 41 27 250 250 82 62 41

Gram = Mass 5 cc = 1 tsp gtts/ml = Drops per milliliter Meter = Length 15 cc = 1 TBS or 3 tsp gtts/min = Drops per minute Liter = Volume 30 cc = 1 ounce Gm = Grams 30 cc = 2 TBS Gtts = Drops 60 mg = 1 Grain Hr = Hour 1 Gram = 15 Grains IVPB = Intravenous Piggyback X = Multiply Mcg = Micrograms x = Unknown answer Min = Minute / = Per or Each

Conversion

Convert grams to milligrams: multiply X 1000 Convert liters to milliliters: multiply X 1000 Convert milligrams to grams: divide by 1000 Convert milliliters to liters: divide by 1000

Mg = Milligrams = Divide Ml = Milliliters - = Minus Dont forget where to place the decimal
SOLUTIONS INDICATIONS ADVANTAGES DISADVANTAGES CONSIDERATIONS 5% Dextrose in water (D5W)

Hypotonic sugar solution To maintain water balance and supply calories necessary for cell metabolism

Is inexpensive and readily available

Causes red cell clumping (cannot be given with blood). Incompatible with some medications May cause water intoxication, low sodium, or

high glucose Not the solution of choice in shock Use only to establish an emergency IV line for drug administration 0.9% Sodium chloride (NS)

Isotonic Initial fluid and electrolyte replacement in all types of hypovolemia Cardiac arrest Is inexpensive and readily available May be used as an initial plasma expander while blood is typed and matched May cause diuresis, high sodium and acid-base imbalance Use cautiously in patients with CHF or renal dysfunction Monitor for S&S of fluid overload. Lactated Ringers

Isotonic Initial fluid replacement in all types of hypovolemia Cardiac arrest Is inexpensive and readily available Rarely causes adverse reactions May lead to volume overload, or CHF Use in caution in patients with liver disease or anorexia May induce low sodium with multiple infusions

GAUGE

USES CONSIDERATIONS

14 Large adolescents or adults Trauma Rapid infusion of fluids and/or blood and blood products Very painful insertion Requires large vein

16 Adolescents and adults Trauma Infusion of large volume of fluids Infusion of blood or blood products Painful insertion Requires large vein

18 Older children, adolescents & adults Fluid resuscitation Infusion of blood, blood components & viscous solutions Obstetric patients

Mildly painful insertion Requires decent sized vein

20 Children, adolescents & adults Suitable for most infusions, TKVO lines Infusion of blood or blood components (Vollote,1989) Commonly used Slower to infuse large amounts of fluid

22

Infants, toddlers, children, adolescents & adults (especially the aged and emaciated) Suitable for most infusions Easier to insert in small, thin, fragile veins Use with slower flow rates Difficult to insert into tough skin 24

Neonates, infants, toddlers Flow rate would be very slow COMPARING PERIPHERAL IV SITES (Loeb, 1992)
ADVANTAGES Easily accessible DISADVANTAGES Wrist mobility decreased unless a short cannula is used

SITE METACARPAL VEINS Located on dorsum of hand; formed by union of digital veins

Adapter lies flat on back of hand

Insertion painful because of large number of nerve endings

In adult or large child, bones of hand act as a splint Site becomes phlebitic more easily Usually first choice for cannulation May be contraindicated with an aged patient as thin skin & loss of connective tissue may predispose to extravasation of blood (Villote, 1989) Uncomfortable position for patient during insertion

BASILIC VEIN Runs along ulnar aspect of forearm & upper arm.

Straight strong vein suitable for large gauge cannula

Painful area to penetrate skin

CEPHALIC VEIN Runs along radial aspect of forearm & upper arm

Large vein readily accepts large gauge cannula

Vein tends to roll on insertion Decreases elbow joint mobility

Does not impair mobility ACCESSORY CEPHALIC VEIN Runs along radius as a continuation of metacarpal veins of the thumb Does not impair mobility Large vein readily accepts large gauge cannula

Vein tends to roll during insertion

Sometimes difficult to position adapter flush with skin

With adapter placed at bend of wrist, movement can cause discomfort or kinking of tubing

ANTECUBITAL VEINS Located in antecubital fossa (median cephalic, located on radial side; median basilic, on ulnar side; median cubital, in front of elbow joint)

Does not require an armboard in older child or adult Often palpable or visible in children when other Difficult to immobilize joint veins will not dilate

May be used for peripheral IV therapy in an emergency or as a last resort

Median cephalic vein crosses in front of brachial artery, increasing the risk of arterial puncture and intra-arterial infusion of medication, resulting in permanent damage

MEDIAN ANTEBRACHIAL VEIN Arises from palm and runs along ulnar aspect of forearm

A last resort when no other sites available

Veins may be small & scarred if blood has been drawn frequently Many nerve endings in area may cause painful venipuncture

DIGITAL VEINS Run along dorsal & lateral portions of fingers (digits)

Last resort for fluid administration or for nonirritating medications

Infiltration occurs easily, increasing risk of nerve damage Finger is splinted with a tongue depressor, limiting mobility

Uncomfortable for patient

Infiltration occurs very easily

Cannot be used if metacarpal veins have already been used

IV FLUID HOURS TO BE INFUSED 24 HOURS 12 HOURS CC/HR 40 cc/hr 80 cc/hr DROP FACTOR 1 5 1 5 1 5 1 5 1 5 1 5 20 20 DROPS/MIN 10 gtts/min 20 gtts/min 25 gtts/min 30 gtts/min 40 gtts/min 60 gtts/min 13 gtts/min 2627gtts/mi n 33 gtts/min 42 gtts/min 53 gtts/min 83 gtts/min

10 HOURS 8 HOURS 6 HOURS 4 HOURS

100 cc/hr 125 cc/hr 160 cc/hr 250 cc/hr

20 20 20 20